What is nasal and paranasal Cancer?
Cancer starts when cells begin to grow out of control. Nasal and paranasal tumors are abnormal growths that begin in and around the passageway within the nose, i.e., the nasal cavity. "Paranasal" means near the nose. Paranasal tumors begin in air-filled chambers around the nose called the paranasal sinuses.
What causes nasal and paranasal cancer?
The exact cause of the nasal and paranasal cancers is yet to be known. These tumours are commonly seen in patients exposed to industrial fumes.
We at CAN-C provide top-quality nasal and paranasal sinus cancer treatment in Bangalore.
Here, you will find information about signs and symptoms, causes and risk factors, types, diagnosis, staging and prevention about nasal and paranasal cancer.
Generally the nasal and paranasal sinus cancers are found because of the problems they cause. Diagnosis in people without symptoms is a rare occurrence and most often accidental (found while checking for other medical problems). Most often these symptoms are only on one side.
Nasal congestion and stuffiness that does not get better or even worsens
Blockage of one side of the nose
Post-nasal drip
Nosebleeds
Pus draining from the nose
Decreased or loss of sense of smell
Numbness or pain in parts of the face
Loosening or numbness of the teeth
Growth or mass of the face, nose, or palate
Trouble opening the mouth
Constant watery eyes
Bulging of one eye
Pain above or below the eyes
Loss or change in vision
Pain or pressure in one of the ears
Hearing loss
Headache
Enlarged lymph nodes in the neck
We offer every individual with a comprehensive and personalized treatment plan for their nasal and paranasal sinus cancer treatment in Bangalore.
Though the exact cause of the nasal and paranasal cancers is unknown, but some of the risk factors for these cancers are well known. A risk factor can be anything that changes or increases the chances of getting a disease like cancer.
Workplace exposures: People working in certain types of jobs related to breathing certain substances while at work are at increased risk for this cancer. For example, it could be nickel and chromium dust, wood dusts from carpentry or saw mill, dusts from textiles, Radium, mustard gas, leather dusts, flour, glues, organic solvents, formaldehyde.
Smoking
Human papillomavirus (HPV) infection: The HPV is a group of over 100 related viruses. HPV has been detected in some cancers of the nasal cavity and paranasal sinuses, though cancers of the nasal cavity or sinuses linked to HPV are very rare.
Some of the common types of nasal and paranasal sinus cancer are:
Squamous epithelial cells can become squamous cell carcinomas. This is the most common type of cancer in the nasal cavity and paranasal sinuses. It is estimated to be a little over half of the cancers of these areas.
Minor salivary gland cells can turn into adenocarcinomas, adenoid cystic carcinomas, and mucoepidermoid cancers. These also are common nasal and paranasal sinus cancers.
Undifferentiated carcinoma is another type of cancer that can come from mucosa cells. This is a fast-growing cancer in which the cells look so abnormal that it is very difficult to identify the type of cell the cancer started in.
Melanocytes are the cells that give the skin its tan or brown color. Melanoma is a type of cancer that starts in these cells. It grows and spreads quickly. Though these forms of cancer are usually found on sun-exposed areas of the skin, sometimes as an exception can also be found on the lining of the nasal cavity and sinuses or other areas inside the body.
Esthesioneuroblastoma is a cancer that starts in the nerve for the sense of smell (olfactory). This cancer is also called as olfactory neuroblastoma. It usually starts in the roof of the nasal cavity and involves the structure cribriform plate. These tumors can sometimes be mistaken for other types of tumors, like undifferentiated carcinoma or lymphoma.
Lymphomas are the cancers starting in the immune system cells called the lymphocytes. It can occur in the nasal cavity and paranasal sinuses. T-cell/natural killer cell nasal-type lymphoma which was previously also called as lethal midline granuloma is one of the most common type of lymphoma seen in this area.
Sarcomas are cancers of muscle, bone, cartilage, and fibrous cells that can start anywhere in the body, including the nasal cavity and paranasal sinuses.
Nasal cavity and paranasal sinus cancers are found because of the signs or symptoms a person exhibits. These are some of the tests done to confirm the cancer.
Medical history and physical exam: The doctor asks questions about the medical history and the problems the person has been facing. A physical exam will also be done so the doctor can look for the signs of nasal cavity or paranasal sinus cancer, as well as any other underlying health problems. Parts of the nose and sinuses are carefully checked for pain, swelling, numbness, firmness, etc.
A further checkup with an otolaryngologist may be advised if deemed necessary by the doctor on the physical exam.
Imaging tests: Imaging tests, they may be used for a number of other reasons both before and after a cancer diagnosis such as to look for a tumor if suspected, to find if a tumor can be safely biopsied, to learn about the cancer spread, to find if it can be removed by surgery, to check if the treatment is working, to check recurrence.
a. Computed tomography (CT) scan: CT scan is very useful in identifying the cancers of the nasal cavity and paranasal sinuses. A CT scan uses x-rays to make detailed 3-D cross-sectional images of the inside of the body. Involvement of bone is well delineated by CT Scan.
b. Magnetic resonance imaging (MRI) scan: Like CT scan MRI scans are also very helpful in identifying cancers of the nasal cavities and paranasal sinuses. MRI scans use radio waves and strong magnets instead of x-rays to make pictures. They are considered better than CT scans in telling whether a change is fluid or a tumor.
Both CT and MRI scans help find cancers of the nasal cavities and paranasal sinuses and learn more about them. They are complementary to each other in evaluating nasal and paranasal tumours and are commonly advised together.
Biopsy: A procedure where a small piece of tissue is taken as sample to be checked under microscope is called as biopsy. This is the only way to know for sure if the patient has nasal cavity or paranasal sinus cancer. There are different types of biopsies done to diagnose nasal cavity or paranasal sinus cancer.
a. Fine needle aspiration (FNA) biopsy
b. Endoscopic biopsy
c. Open biopsy
The staging system most often used for the nasal cavity and paranasal sinus cancers is the TNM system, which is based on 3 key pieces of information:
The extent of the main tumor (T): Where is the tumor? How far has it grown into nearby structures?
The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes in the neck? If so, how many are affected, and how large are they?
The spread (metastasis) to distant sites (M): Has the cancer spread to distant parts of the body? (The lungs are the most common site of spread, although it can also spread to other organs, such as the bones.)
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.
Once the T, N, and M categories of the cancer have been determined, this information is combined in a process called stage grouping to assign an overall stage.
We at CAN-C provide nasal and paranasal sinus cancer treatment in Bangalore.
It is not possible to prevent all nasal cavity and paranasal sinus cancers, but the risk of developing them can be reduced to a large extent by avoiding certain risk factors, such as the workplace exposures to certain substances. Recently, the awareness of the possible danger from such exposures has increased, and workplace safety measures are put in place.
Cigarette smoking is another major risk factor which is an avoidable one for cancers of the nasal cavity and sinuses.
Currently, there is no way to prevent most of these cancers as most of the people with cancer of the nasal cavity and paranasal sinuses have no known risk factors.
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How Nasal And Paranasal Sinus Cancer is treated?
When diagnosed with nasal and paranasal sinus cancer, it is very important to be aware of the options and weigh the risks and benefits of each treatment. There are ways to treat nasal and paranasal sinus cancer. The treatment a patient gets depends on the type and stage of the cancer. It also depends on the patient's age, general health, and other things that are unique. Most cases of nasal and paranasal sinus cancer can be cured with treatment. In Bangalore, we at CAN-C provide excellent treatment for nasal and paranasal sinus cancer.
Surgery is a key part of treatment to treat most forms of the nasal cavity or paranasal sinus cancers.
The nasal cavity and paranasal sinuses are close to many important nerves, blood vessels, and structures. Due to this, the surgery is of a complex nature and also the fact that these cancers are quite rare, it becomes very important to have highly experienced hands to perform surgery for these cancers.
1. Wide local excision: In this procedure the tumor is removed along with an edge of normal tissue around it keeping in mind that no cancer cells remain.
2. External ethmoidectomy: In this type of procedure, if the tumor is small then an ethmoidectomy may be done.
3. Maxillectomy: If the tumor also has grown into the maxillary sinus, then maxillectomy may be done. The type of maxillectomy depends on where the tumor is and whether it has grown into nearby tissues.
4. Craniofacial resection: If the cancer is in advanced stage and has spread into the base of the skull or brain, or is in the ethmoid sinuses, frontal sinuses, and/or the sphenoid sinuses then the procedure craniofacial resection may be done.
5. Endoscopic surgery: In this form of surgery, an endoscope is used to see and remove the tumor. This way, the surgeon will not have to cut through the skin and bone. This reduces normal tissue damage.
6. Neck dissection: Sometimes cancers of the nasal cavity or paranasal sinuses spread to the lymph nodes in the neck. The removal of these lymph nodes depending on the stage and location of the cancer is known as neck dissection.
There are several types of neck dissection procedures. Their goals are to remove lymph nodes known to or likely to contain cancer.
a. A partial or selective neck dissection.
b. A modified radical neck dissection.
c. A radical neck dissection.
Radiation therapy uses high-energy radiation to kill cancer cells.
It is used in many ways to treat nasal and paranasal sinus cancers.
After surgery, radiation can be used to try to kill any small residues of cancer that may remain, which is called as adjuvant treatment.
Radiation used to ease problems caused by the cancer, like pain, bleeding, and trouble swallowing is called as palliative treatment.
Sometimes chemotherapy is given along with the radiation which is called as chemoradiation.
There are 2 major types of radiation therapy. They are:
1. External beam radiation therapy.
a. Three-dimensional conformal radiation therapy (3D-CRT): 3D-CRT uses the results of imaging tests such as MRI and special computers to map the exact location of the tumor.
b. Intensity modulated radiation therapy (IMRT): IMRT is an advanced form of 3D therapy. IMRT is the standard way to deliver external beam radiation for these cancers.
2. Internal radiation also called as brachytherapy or interstitial radiation.
CAN-C: Top centre for nasal and paranasal sinus cancer treatment (in Bangalore).
Chemotherapy (chemo) uses anti-cancer drugs either through an IV or taken by mouth. These drugs enter the bloodstream reaching all the areas of the body, making this treatment useful for cancer that has spread to organs beyond the nasal cavity and paranasal sinuses. It is used in many ways.
Before surgery (often along with radiation therapy) to try to shrink the tumor and make easier to take out all of it. This is called neoadjuvant chemotherapy. It may also be called induction chemotherapy. It may also be used before surgery to quickly ease symptoms the tumor is causing.
As the main treatment (often along with radiation therapy) for cancers that are too big or have spread too far into nearby tissues to be completely removed with surgery.
It may be used to control cancer growth and spread when it has spread to the other parts of the body and cannot be treated with surgery or radiation and is called as palliative care.
Chemoradiation: Also called chemoradiotherapy is chemotherapy given at the same time as radiation. This has been shown to shrink some of these tumors more.
Some of the chemo drugs used to treat these carcinomas are cisplatin, carboplatin, 5-fluorouracil, docetaxel, paclitaxel, and Methotrexate.
With more advancement in medical researches and studies more is known about the changes in cells that cause cancer. Newer drugs have been formulated that specifically target these changes, which is known as targeted therapy. Targeted drugs work differently from standard chemo drugs. It is observed that they most often have different and lesser severe side effects.
Cetuximab is a monoclonal antibody, which is a man-made version of an immune system protein. It targets epidermal growth factor receptor (EGFR), a protein on the surface of certain cells that helps them grow and divide. Nasal cavity and paranasal sinus cancer cells often have more than normal amounts of EGFR. By blocking EGFR, cetuximab can slow or stop cancer cell growth.
Cetuximab may be used to treat more advanced cancers.
We provide best treatment for nasal and paranasal sinus cancer in Bangalore.
Immunotherapy is the use of medicines that help a person's own immune system find and destroy cancer cells. It can be used to treat some people with nasal cavity or paranasal sinus cancer.
Immune checkpoint inhibitors: An important part of the immune system is the ability to keep itself from attacking the normal cells. It uses "checkpoints" - proteins on immune cells that need to be turned on/off to initiate an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. But newer drugs that target these checkpoints hold a lot of promise as cancer treatments.
These drugs can be used after chemotherapy in people with nasal cavity or paranasal sinus cancer that has returned after treatment or that has spread to other parts of the body.
While it is undoubtedly very important to remove or destroy cancer cells or even slow their growth, it is equally important to maintain the patient's quality of life. This is irrespective of whether treatment is being used to cure the cancer or if the cancer has spread and cannot be cured.
When the treatment is for cure, palliative treatments can help ease symptoms from the main cancer treatment itself.
But if the cancer is already in advanced stage, then palliative treatment plays an even more important role in helping to keep the person comfortable and maintain the quality of life for as long as possible.
Nutrition is another important concern for people with head and neck cancers such as nasal cavity or paranasal sinus cancers. Both the cancer and its treatment can make it hard to swallow. If this affects how a person eats or drinks, they may need to have a feeding tube inserted into the stomach.
There are many other ways the doctor can help maintain the quality of life and control the symptoms.